Abstract
To the Editor: Maternal serum alpha-fetoprotein screening at 16 to 18 weeks of gestation is being offered to a steadily increasing proportion of pregnant women in the United States. Elevated maternal serum alpha-fetoprotein levels lead to the detection of almost all fetuses with anencephaly and about two thirds of those with spina bifida1 , 2 and also help to identify pregnancies at high risk for fetal death and low birth weight.3 Most recently, low maternal alpha-fetoprotein values have been found in association with Down's syndrome in the fetus,4 suggesting that about 20 per cent of such fetuses could be detected in . . .

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